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Ann Epidemiol. 2004 Jul;14(6):416-24.

Synergism between smoking and vital exhaustion in the risk of ischemic stroke: evidence from the ARIC study.

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  • 1Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL 33612, USA. sschwartz@hsc.usf.edu

Abstract

PURPOSE:

To examine the synergism between vital exhaustion and cigarette smoking in producing ischemic stroke. Vital exhaustion (VE), a state characterized by unusual fatigue, irritability, and feelings of demoralization, is measured by the Maastricht questionnaire (MQ), a 21-item inventory of symptoms.

METHODS:

The Atherosclerosis Risk in Communities (ARIC) Study is an ongoing cohort study, initiated in 1987. The MQ was administered at the second follow-up visit (1990-1992), and participants were subsequently followed for an average of 6.27 years. Four US communities (Minneapolis, Minnesota; Washington County, Maryland; Forsyth County, North Carolina; and Jackson, Mississippi). 13,066 participants aged 48 to 67 years at baseline (Visit 2) with no history of stroke. Validated hospitalized ischemic stroke.

RESULTS:

During the follow-up period, there were 202 incident ischemic strokes. After multivariate adjustment, current smoking, and high VE were independent risk factors for incident stroke: (smoking vs. non-smoking HR=1.76, p < 0.01; high VE vs. low VE HR=1.94, p < 0.01). For persons with both VE and smoking vs. persons with neither, HR=2.71 (p < 0.001). The proportion of stroke disease burden due to VE and smoking that could be attributed to their interaction was 81 to 93 percent.

CONCLUSIONS:

The combination of cigarette smoking and VE is synergistic in the production of stroke.

[PubMed - indexed for MEDLINE]
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